| NPI | 1902675408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICKENSY LEIGH ELLIS-WHITE Owner 765-893-1790 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-12-26 |
| Last Update Date | 2024-09-30 |