| NPI | 1811482847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS JOHNSON Owner 315-313-5979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: MI 4101006640) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2018-06-22 |