| NPI | 1306470125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC C LOGAN CEO 270-339-0717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 251S00000X | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2021-04-24 |