| NPI | 1881375707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRAN PATEL Provider 551-697-9971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2024-05-07 |