| NPI | 1356442099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENESSA L FOWLKES Billing Supervisor 318-473-0863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2008-04-17 |