| NPI | 1497985295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVARRA SCOTT CLARK Co Owner 318-308-1105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 37092488K) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2009-07-15 |