| NPI | 1861070260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN TYLER TERRUSA Member/Chief Administrative Officer 818-251-0123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2021-06-26 |