| NPI | 1871992206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY FULLER Billing Clerk 660-890-8076 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MO 2000165271) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: MO 2000165271) |
| Enumeration Date | 2014-08-21 |
| Last Update Date | 2014-08-21 |