| NPI | 1043774516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA LYNN SULLIVAN Owner 479-372-7446 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2019-01-29 |