| NPI | 1093208548 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW JUSTIN THRASHER Clinical Director 337-625-5766 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 1412) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: LA AP05308) |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2018-06-10 |