| NPI | 1912268467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA WICKERSHAM Owner 702-513-8321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2012-05-31 |