| NPI | 1972977015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE MARIE BAST Clinical Mental Health Counselor 262-617-6446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0174601) |
| Enumeration Date | 2015-11-29 |
| Last Update Date | 2015-11-29 |