| NPI | 1487538732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA M WILBURN-BECKHOM Clinical Director 229-255-0066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2025-07-31 |
| Last Update Date | 2025-07-31 |