| NPI | 1881387355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NYIRRAH GODDARD Co Owner 937-422-1914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0801X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-05-31 |