| NPI | 1134628654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN K COOPER Manager 318-446-0231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2018-02-10 |
| Last Update Date | 2018-02-10 |