| NPI | 1740686823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY LYNN LOPEZ Sole Member/Owner 262-955-9804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2014-11-17 |