| NPI | 1902573355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA LYLE Billing Nanager 667-212-3626 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2021-08-24 |