| NPI | 1356493530 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE JACOB COO 318-746-0420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X (Licence: LA 1548839) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2023-07-24 |