| NPI | 1730906637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA ANDERSON President 833-759-8720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 111N00000X Chiropractor |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 133V00000X Dietitian, Registered | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2026-03-15 |