| NPI | 1710744685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NASIRA MAH-JABEEN Credentialing Agent 502-384-5149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-03-06 |
| Last Update Date | 2024-03-06 |