| NPI | 1366112823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOELLEN MARION President 270-202-8669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103G00000X Clinical Neuropsychologist | |
| 103TC0700X Psychologist, Clinical | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2024-11-15 |