| NPI | 1770361065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD E HONN Program Administrator 855-984-1788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2023-12-07 |