| NPI | 1356074165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAMON WAYNE HUTSON CEO 918-808-0092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QH0700X Clinic/Center Hearing and Speech | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM1300X Clinic/Center Multi-Specialty | |
| 261QP2000X Clinic/Center Physical Therapy | |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-07-13 |