| NPI | 1932178183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA CHRISTOPHER Contracting & Credentialing COO Rdin 563-327-0203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YS0200X Counselor School | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 101YM0800X Counselor Mental Health | |
| 1041S0200X Social Worker School | |
| 122300000X Dentist | |
| 1223D0001X Dentist Dental Public Health | |
| 1223G0001X Dentist General Practice | |
| 126900000X Dental Laboratory Technician | |
| 1223P0221X Dentist Pediatric Dentistry | |
| 124Q00000X Dental Hygienist | |
| 251S00000X Community/Behavioral Health | |
| 126800000X Dental Assistant | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2025-04-11 |