| NPI | 1831736289 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA M IKE Owner 701-580-0662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-12-04 |
| Last Update Date | 2019-12-12 |