| NPI | 1912612201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA C JOHNSON Lpcc 701-650-0679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2023-02-17 |