| NPI | 1710640974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN QUIST Deputy Director 916-875-9904 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2022-07-08 |