| NPI | 1902673155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN ORLANDO KLASS Manager 833-877-9243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 102L00000X Psychoanalyst | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 251S00000X | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-12-07 |
| Last Update Date | 2023-12-07 |