| NPI | 1407073349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHLAN RAYMO Program Director 318-648-9697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 6707) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-08-22 |