| NPI | 1821870460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHANNES ORTNER CEO 332-209-7808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC1900X Psychologist, Counseling | |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2023-10-18 |