| NPI | 1336018373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLEY MICHELLE ELAM Provider 918-500-7629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2025-10-29 |
| Last Update Date | 2025-10-29 |