| NPI | 1043619992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK S DEBORD Licensed Clinical Social Worker 318-381-9070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: LA 1947) |
| Enumeration Date | 2014-08-16 |
| Last Update Date | 2014-08-16 |