| NPI | 1922105147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANA ESBENSHADE Billing Supervisor 330-798-8005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: OH 0137) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2025-05-08 |