| NPI | 1568052090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALYNDA L GASTON Billing Clerk 662-627-7267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2021-01-19 |