| NPI | 1871380014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL M GREEN Director Of Clinical Supervision 267-595-0588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-04-22 |
| Last Update Date | 2025-04-22 |