| NPI | 1750167052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY SHEPARD Director Of Federal Programs 833-203-4300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-09-04 |
| Last Update Date | 2023-09-04 |