| NPI | 1942020003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZACHARY JENSON CEO 385-352-9746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 2083A0300X Preventive Medicine, Addiction Medicine | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2024-10-28 |