| NPI | 1912413535 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC SHAPIRO CFO 667-239-3293 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2021-06-10 |