| NPI | 1487028163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA TAYLOR Administrator 318-509-9376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |