| NPI | 1093092694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TOMICA HENDERSON Owner 318-771-6228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2011-11-10 |