| NPI | 1376010934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA L GIVEANS Np 985-290-0402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2018-10-31 |