| NPI | 1871288845 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH LANE Owner 940-200-3199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-04-06 |
| Last Update Date | 2024-03-27 |