| NPI | 1750058244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK D BRAATZ Credentialing Specialist 844-646-3247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2026-08-05 |