| NPI | 1104657642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KACEY CALLISON Authorized Official 918-237-1281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2025-04-09 |