| NPI | 1912614413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORINNE BAILEY Credentialing Specialist 877-634-7333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 163WP0808X Registered Nurse, Psych/Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 208000000X Pediatrics | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 208VP0000X Pain Medicine, Pain Medicine | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2022-11-03 |