| NPI | 1487021788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY M JOHNSON Agency Manager 318-600-6838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2015-08-22 |
| Last Update Date | 2023-06-15 |