Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Mental Health (Including Community Mental Health Center) |
261QM0801X | B4[14] | Community Mental Health Center | |
Group Psychotherapy |
103TP2701X | 62 | Psychologist, Clinical |
| NPI Number | 1538122445 |
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| LBN Legal business name | SWEETSER | ||||||||
| Authorized official | JAYNE VAN BRAMER - (CEO) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 04/11/2006 | ||||||||
| Last updated | 03/10/2023 - About 3 years ago | ||||||||
| Identifiers |
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