| NPI | 1306408216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA RENE VEST Billing Director 662-625-7111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2020-02-26 |