| NPI | 1851042279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE PHELPS Owner 971-339-1662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2022-01-18 |
| Last Update Date | 2022-01-18 |