| NPI | 1962771394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY LYNN MOORE Clinical Social Worker 614-398-1180 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2011-12-13 |