| NPI | 1902057045 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARON T. DENNISTON Physican 814-456-1863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) (Licence: PA MD044333L) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2008-10-07 |