| NPI | 1073078564 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY DOSS Billing Supervisor 662-323-9318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2024-05-22 |