| NPI | 1427540210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY RENEE MATLOCK Owner 870-424-0570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2018-06-06 |