| NPI | 1083862353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERALD WAYNE BAMBURG Executive Director 318-442-4498 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 951) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: LA 951) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: LA 951) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: LA 951) | |
| 103TF0200X Psychologist, Forensic (Licence: LA 951) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: LA 951) | |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2008-08-28 |