| NPI | 1770126989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LYDIA DAVIS Owner 907-953-9614 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2019-10-21 |