| NPI | 1821785205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC SHAPIRO CFO 667-239-3293 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TF0000X Psychologist, Family |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-08-22 |