NPI | 1043692437 |
---|---|
Entity Type | Organization |
Authorized Contact | JOHN A TEAL Medical Psychologist 601-946-1844 |
Organization Subpart ? | No |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: LA MP.000036) |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: LA LPC #3492) |
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: LA MP.0020) | |
Enumeration Date | 2015-06-23 |
Last Update Date | 2015-07-29 |