NPI | 1801337415 |
---|---|
Other Name | THERESA SCULLY |
Entity Type | Organization |
Authorized Contact | THERESA E SCULLY Owner/Practioner 701-570-4602 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ND 4970) |
Additional Taxonomies | 261QM0801X (Licence: ND 4970) |
Enumeration Date | 2017-03-15 |
Last Update Date | 2018-09-13 |