| NPI | 1770109035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLE JEAN WILSON Partner 419-357-4960 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-06-23 |