| NPI | 1497632764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HANNAH GAGE Owner 479-208-7214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-08-19 |
| Last Update Date | 2025-08-22 |