| NPI | 1235340761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISA M VANDENBERG Administrator 318-251-2322 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA 1164R) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA CI 3505 LA) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2010-09-01 |