| NPI | 1720934615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY EASTON THUESON Manager 385-399-8787 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry |
| Enumeration Date | 2026-03-05 |
| Last Update Date | 2026-03-05 |