| NPI | 1326771379 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN FURDGE Counselor 662-306-0732 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-10-17 |