| NPI | 1508312513 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE M NAQUIN-BOLTON Owner 985-859-7097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: LA 4385) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: LA 4385) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-08-30 |