| NPI | 1366875874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL W ROBERTSON Accounting Supervisor 318-862-3067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: LA 2203782546-B) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2015-12-03 |