| NPI | 1790429652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY KAY JOHNSON Clinical Therapist 605-881-0860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 251S00000X | |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2022-05-04 |