| NPI | 1780053868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI MARIE LIETZ Counselor 360-608-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR R3860) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2015-09-18 |