| NPI | 1851358204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KING Director, Credentialing Enrollment 800-370-3651 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 364SP0808X Clinical Nurse Specialist, Psych/Mental Health | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2018-02-21 |