| NPI | 1275364002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIME VARNEY CEO 270-225-4033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0600X Psychiatry & Neurology Clinical Neurophysiology |
| Additional Taxonomies | 261QD1600X Clinic/Center Developmental Disabilities |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-08-13 |