| NPI | 1396081097 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA MICHELLE PHILLIPS Business Manager 318-617-5869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: LA 10334076#LUL73) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 10334076#LUL73) |
| 251B00000X Case Management (Licence: LA 10334076#LUL73) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2023-06-28 |