| NPI | 1730862491 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GUAN Q ELLERBE Owner 774-220-4060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 251S00000X | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2025-02-14 |