| NPI | 1104494822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESIRAE DAWN TROTTER Executive Assistant 405-326-0688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2025-04-09 |