| NPI | 1336491349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY SHANIQUE SHOALS Ex Clinical Director 405-601-4004 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2012-10-15 |