| NPI | 1275290967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA CLARK Owner 270-535-2545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2021-11-19 |