| NPI | 1467851667 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY LOU CANTRELL Sole Owner 606-743-2407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY PSYPPR00193411) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2014-08-14 |