| NPI | 1760994685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES DALE HUSELTON Member 814-807-1316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2017-11-01 |