| NPI | 1962176529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN MUCINO MARTINEZ Sr. Credentialing Specialist 888-588-8995 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2023-08-16 |