| NPI | 1467485110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINA SMITH Admininstrator 270-251-3666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2021-11-18 |