| NPI | 1558926113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIERRA HEARD Owner 318-820-6476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2019-05-08 |