| NPI | 1720728561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLEEN LAUREN GONDEN CEO 667-288-1566 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 104100000X Social Worker |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 251S00000X Community/Behavioral Health | |
| 261Q00000X Clinic/Center | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2025-06-06 |