| NPI | 1285938209 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HANNAH MEDLEY Credentialing Manager 270-670-1461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2022-03-16 |