| NPI | 1063393502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER MCQUAY Director Of Accounts 870-604-4455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2026-03-09 |