| NPI | 1457773657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS STAATS Doctor 318-834-3925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: LA 254) |
| Enumeration Date | 2014-01-08 |
| Last Update Date | 2016-02-17 |