| NPI | 1265018683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATLYNNE WELLS Owner 479-335-6482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2021-03-30 |