| NPI | 1326617689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERICA LAYNE MITCHELL Provider/Owner 225-888-3628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2021-06-22 |