| NPI | 1912566464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAPHAEL FORD Director 414-517-7607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2019-06-09 |
| Last Update Date | 2019-06-09 |