| NPI | 1831873744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ERIKA PEDERSEN Owner 806-543-1429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-26 |