| NPI | 1386519437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH MAKAMSON Member 662-400-3009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-10-08 |
| Last Update Date | 2025-10-08 |