| NPI | 1760244545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH MYERS Contract Credentialing Specialist 866-912-2746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2024-01-26 |