| NPI | 1740865526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY DAVIES Director Of Clinic Services 385-382-1555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2021-03-13 |
| Last Update Date | 2024-08-13 |