| NPI | 1861210056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONNIE MANNS Owner 779-207-2047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-09-27 |
| Last Update Date | 2024-09-27 |