| NPI | 1760136964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK BAILEY Co Owner 218-209-2150 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2023-08-25 |