| NPI | 1982009247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE EARNEST Insurance And Credentialing Coordin 458-231-1355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 1500011088) |
| Additional Taxonomies | 208000000X Pediatrics |
| 225100000X Physical Therapist | |
| 171M00000X Case Manager/Care Coordinator | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2026-04-08 |