| NPI | 1043033590 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAITLYN PARKMAN Owner 618-520-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-11-04 |
| Last Update Date | 2024-11-04 |