| NPI | 1063939247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK SAMUEL THOMASON Counselor/Owner 501-551-1943 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X (Licence: OK 6461) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: OK 6461) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: OK 6461) | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2022-07-21 |