| NPI | 1518747567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY GRACE Clinic Manager 662-325-0621 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2025-02-19 |