| NPI | 1962284638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TORIA WYSOR Managing Director 702-578-5982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-10-17 |
| Last Update Date | 2023-10-24 |