| NPI | 1760920474 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON JOSHUA EZRA Treasurer 888-818-9915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 101YP1600X Counselor Pastoral | |
| 101YP2500X Counselor Professional | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |