| NPI | 1811861511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAELLE VALCOURT Credentialing 005-457-5707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-10-03 |
| Last Update Date | 2025-10-03 |