| NPI | 1780105551 |
|---|---|
| Doing Business As | CLEMENTINE MALIBU LAKE |
| Entity Type | Organization |
| Authorized Contact | MIKE BAGLEY Chief Financial Officer 305-663-1876 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2020-05-27 |