| NPI | 1588176150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CHARLES SHOPTAUGH Owner 225-928-2468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: LA MD205916) |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2017-12-06 |