| NPI | 1730833567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORDELL D HARRIS CEO 725-735-0456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TC0700X Psychologist Clinical | |
| 1041C0700X Social Worker Clinical | |
| 207Q00000X Family Medicine | |
| 261QM2500X Clinic/Center Medical Specialty | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2022-02-10 |
| Last Update Date | 2022-02-10 |