| NPI | 1144942095 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY L FELTY Owner 870-240-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2022-09-16 |