| NPI | 1760272512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER VANCE Contact Person 877-829-5500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-05-06 |
| Last Update Date | 2025-05-06 |