| NPI | 1063965242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE ELIZABETH WALL Owner 270-792-9683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3483) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |