| NPI | 1790382455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORINNE BAILEY Credentialing Specialist 877-634-7333 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional | |
| 1041C0700X Social Worker Clinical | |
| 163W00000X Registered Nurse | |
| 171M00000X Case Manager/Care Coordinator | |
| 2084A0401X Psychiatry & Neurology Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 208VP0000X Pain Medicine Pain Medicine | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2024-07-29 |