| NPI | 1124556949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHON BRETT TRAYLOR Owner 870-310-2343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 4235) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2017-05-24 |