| NPI | 1821714015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | INGRID PONCIANO Owner 620-481-3135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2022-10-18 |