| NPI | 1104210699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS LEACH CFO 606-329-8588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2015-03-24 |