| NPI | 1902434236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNWICK NATHAN President 888-900-8082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 2084A0401X Psychiatry & Neurology Addiction Medicine | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 363LP2300X Nurse Practitioner Primary Care | |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2020-03-31 |