| NPI | 1801597802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLISON M DETLOFF Clinical Psychologist 608-740-0290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2023-08-24 |