| NPI | 1588858104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS E STAATS Owner 318-861-0194 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 254) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: LA 254) |
| 103TC1900X Psychologist, Counseling (Licence: LA 254) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2007-11-05 |