| NPI | 1932834819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY LYNN ROSEN Owner 774-260-5685 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-07-23 |
| Last Update Date | 2024-06-21 |