| NPI | 1023566999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDEE LYNN MASTERSON Executive Director 731-234-1873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CO 1-14-17291) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2021-04-14 |