| NPI | 1316461007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN COOPER Manager 318-446-0231 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2022-07-21 |