| NPI | 1295363182 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PERRY BOLTON PRATT Ownter 731-803-4652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2020-03-28 |