| NPI | 1497502652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICA SIEGEL Owner/Manager 662-607-1563 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-05-03 |
| Last Update Date | 2024-05-03 |