| NPI | 1982084349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENNA LEIGH EDWARDS Business Manager 231-638-5316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2024-07-01 |