| NPI | 1922161926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON WILBER Executive Director 715-799-3861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2022-12-28 |