| NPI | 1750717294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE CHERRY Clinical Director 385-244-9468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: UT 1020139) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2013-09-16 |