| NPI | 1750983581 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACIE CLARK Owner 888-338-7293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| 207Q00000X Family Medicine | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| 207R00000X Internal Medicine | |
| 385HR2065X Respite Care, Respite Care, Physical Disabilities, Child | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2022-05-04 |