| NPI | 1760437271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KING Director, Credentialing Enrollment 800-370-3651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2017-07-11 |