| NPI | 1477070324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE HARRELL Owner 318-208-8908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2024-02-13 |