| NPI | 1083279715 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN PURCELL Credentialing 270-779-9175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2019-05-08 |