| NPI | 1154043495 |
|---|---|
| Former Legal Business Name | PRISM PSYCH, PLLC |
| Entity Type | Organization |
| Authorized Contact | LATOYA R FAVRE Licensed Psychologist 423-748-2966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2022-09-14 |