| NPI | 1851066518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA COSTE Owner 262-470-5811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2024-06-04 |