| NPI | 1902452808 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN TOLBERT Owner 877-799-1506 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 102L00000X Psychoanalyst | |
| 103K00000X Behavior Analyst | |
| 261QC1800X Clinic/Center, Corporate Health | |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2020-02-05 |