| NPI | 1881154953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA KAY REYNOLDS WEIDENDORF Owner 218-245-5073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2019-03-23 |