| 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 |