| NPI | 1972345338 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA INGRAM Vice President 712-899-0763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2024-06-07 |
| Last Update Date | 2024-06-07 |