| NPI | 1710706353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVIDA COOK Owner 937-367-4185 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2026-01-29 |