| NPI | 1467888552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIE LEIGH WILSON Owner 636-255-0002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2024-01-30 |