| NPI | 1912613449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN MATHIS Dnp Pmhnp Fnp 844-793-1923 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| 207Q00000X Family Medicine | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2023-01-27 |