| NPI | 1821442518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA PORTER Credentialing Manager 660-890-8186 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2016-04-21 |