| NPI | 1093194151 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIAN FISHER Director 318-614-7644 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA sa0010541) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2015-05-22 |