| NPI | 1083162465 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE JACOB COO 318-746-0420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2023-07-24 |