| NPI | 1396353116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA BAKER Lpc 479-269-5782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2020-08-27 |