| NPI | 1407447725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DWAYNE REMON TATE Owner 918-291-9142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-01-29 |
| Last Update Date | 2021-10-13 |