| NPI | 1417258625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY HAMILTON Licensed Clinical Social Worker 662-349-2818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: MS C5871) |
| Additional Taxonomies | 261QA0005X Clinic/Center Ambulatory Family Planning Facility (Licence: MS C5871) |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: MS C5871) | |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2010-11-04 |