| NPI | 1164699096 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STARKE R FARRELL Manager 662-993-9024 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MS C6287) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2015-11-17 |