| NPI | 1407133721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE S CLARK Managing Member 225-413-3922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 8738) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2011-11-15 |