| NPI | 1720754492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARA MARIE MUMFORD Owner 234-600-8200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC0700X Psychologist, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2021-08-21 |
| Last Update Date | 2021-08-21 |