| NPI | 1356582324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT A JACKSON Director 417-234-9023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2006005127) |
| Enumeration Date | 2009-03-20 |
| Last Update Date | 2009-03-20 |