| NPI | 1912356551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVOR SCOTT PHIPPS Owner 641-745-0639 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 008212) |
| Enumeration Date | 2016-06-04 |
| Last Update Date | 2016-06-04 |