| NPI | 1528603743 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRISCILLA ROTH-WALL Psychologist/Owner 662-603-1035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2019-11-12 |
| Last Update Date | 2019-11-12 |