NPI | 1184761553 |
---|---|
Former Name | WILLIE L HASKINS |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: OK LPC 2868) |
Enumeration Date | 2007-02-01 |
Last Update Date | 2007-07-09 |