| NPI | 1972643203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA BUSCH Dir. Of Contract And Credentialing 445-206-3028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 261Q00000X Clinic/Center | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0400X Clinic/Center, Rehabilitation | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2025-02-16 |