| NPI | 1174404271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER SISSON Owner 731-693-0713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-09-08 |