| NPI | 1750191870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFANIE RUSHATAKANKOVIT Owner/President 424-307-5007 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2025-01-10 |
| Last Update Date | 2025-01-10 |