| NPI | 1992385462 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM LA VALLE Co President 833-742-2737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261Q00000X Clinic/Center | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-04-09 |
| Last Update Date | 2024-01-29 |