| NPI | 1942706643 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLE PERALTA AZOR Owner 308-249-7853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1240) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2024-04-17 |