| NPI | 1154549285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE JACOB CFO 318-747-8895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2023-07-24 |