| NPI | 1972088912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY WOOD Administrator 855-732-5292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0805X Psychiatry & Neurology, Geriatric Psychiatry |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2018-09-26 |