| NPI | 1568199768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY LEE EVELAND Co Owner 580-656-2623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-08-07 |
| Last Update Date | 2024-03-05 |