| NPI | 1720276298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINA ROOD Sr It Syst EMS Analyst 234-312-5193 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2022-12-15 |