| NPI | 1093410243 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM KLEIN COO 662-205-0098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 2084P0802X Psychiatry & Neurology, Addiction Psychiatry |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 208D00000X General Practice | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2025-12-10 |