| NPI | 1972714301 |
|---|---|
| Other Name | FEE FOR SERVICE - MIXED SPECIALTY GROUP |
| Entity Type | Organization |
| Authorized Contact | DENISE C HUNT Behavioral Health Director 209-525-6225 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2020-08-22 |