| NPI | 1033510391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY ANN KELLY Counselor 662-760-0115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 1923) |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2014-09-05 |