| NPI | 1881371540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILY L RUSS Owner 920-475-0333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2024-06-07 |