| NPI | 1174991186 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA ANN WATSON Program Director 318-787-1114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 6319) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: LA 6319) |
| Enumeration Date | 2015-09-08 |
| Last Update Date | 2015-09-08 |