| NPI | 1790647824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA WALTER Licensed Professional Counselor (Lp 870-707-1467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| 261QC0050X Clinic/Center, Critical Access Hospital | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2025-11-26 |
| Last Update Date | 2025-11-26 |