| NPI | 1811614811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISA ROBERTS Owner 385-251-7285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |