| NPI | 1376143024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY LYNN OLLAR Office Manager 662-892-2885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TC1900X Psychologist, Counseling | |
| 207Q00000X Family Medicine | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2023-09-18 |