| NPI | 1942741269 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES KELLERMANN Executive Director 619-397-0968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 04018) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2017-04-19 |