PREMIER CHOICE BEHAVIORAL HEALTH AND WELLNESS CLINIC, LLC

Clinic/Center — Mental Health (Including Community Mental Health Center)

Code: 261QM0801X

Clinic/Center — Adult Mental Health

Code: 261QM0850X

Clinic/Center — Adolescent and Children Mental Health

Code: 261QM0855X

Clinic/Center — Multi-Specialty

Code: 261QM1300X

Clinic/Center — Primary Care

Code: 261QP2300X