| NPI | 1205514874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC ALLEN Counselor 731-439-1504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2025-04-08 |