| NPI | 1013353101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL S RANALLO Secretary 270-417-4813 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| 103TC1900X Psychologist Counseling | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2025-06-02 |