| NPI | 1154875524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEITH WILSON Lpc 417-619-9598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MO 2014038425) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2016-08-15 |