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 Community/Behavioral Health |
261QM0855X Clinic/Center Adolescent and Children Mental Health | |
Enumeration Date | 2023-12-26 |
Last Update Date | 2024-01-17 |