| NPI | 1487427894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY FULKERSON Lcsw 270-240-5312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-11-07 |
| Last Update Date | 2024-04-17 |