| NPI | 1881486595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY M PARKS Lac 520-392-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC1900X Psychologist, Counseling | |
| Enumeration Date | 2025-05-19 |
| Last Update Date | 2025-05-19 |