| NPI | 1063074771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN HAASTRUP Owner 270-871-7379 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251S00000X |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2021-09-20 |