| NPI | 1396353116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA BAKER Lpc 479-269-5782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2025-12-11 |