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 |