| NPI | 1881307528 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACLYN BECKER Owner 385-437-0474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 2084P0802X Psychiatry & Neurology, Addiction Psychiatry | |
| 225C00000X Rehabilitation Counselor | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2022-12-27 |
| Last Update Date | 2022-12-27 |