| NPI | 1770143109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY LISS Clinical Social Worker 269-598-3886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2019-06-18 |