| NPI | 1720712094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD BRUNTON Director Of Operations 267-664-0734 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| 133V00000X Dietitian, Registered | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2022-07-13 |