| NPI | 1568799658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLY KELLER Owner/President 870-932-3600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center Rehabilitation |
| Additional Taxonomies | 261QD1600X Clinic/Center Developmental Disabilities |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2020-11-30 |