NPI | 1174157689 |
---|---|
Entity Type | Organization |
Authorized Contact | COLBY PONDER Owner 662-305-5998 |
Organization Subpart ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2020-02-24 |
Last Update Date | 2024-09-11 |