| NPI | 1265174775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID COOK Manager 731-267-3154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2022-10-25 |