| NPI | 1376314385 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE FALLIS Owner 318-218-2360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2024-01-10 |