| NPI | 1760216915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAVELYN MILLARD Director 800-681-1403 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101Y00000X Counselor |
| 235Z00000X Speech-Language Pathologist, | |
| 225X00000X Occupational Therapist | |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2026-03-10 |