| NPI | 1134522253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LANDRY FULTZ Lcsw 318-305-9210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 11307) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-10-02 |