| NPI | 1982054524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN RUDEN Owner 712-541-2597 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IA 001719) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 001719) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2025-05-19 |