NPI | 1720745151 |
---|---|
Entity Type | Organization |
Authorized Contact | TRACI-ANN MILLER Onwer 754-799-7991 |
Organization Subpart ? | No |
Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
Enumeration Date | 2021-11-19 |
Last Update Date | 2021-12-02 |