| NPI | 1811618499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY BROWN Billing Specialist 667-678-4050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2022-09-12 |