| NPI | 1831795095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER GREEN Member 769-226-6232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2020-12-11 |