| NPI | 1366201204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA BLAIR Clinical Director/Therapist 270-629-6836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-03-23 |