| NPI | 1578913885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN HARRELL Business Manager 662-510-8606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS 901502) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2024-01-09 |