| NPI | 1972073633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRESTON GREENE Program Director 231-881-2538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2019-06-11 |