| NPI | 1598454639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTNEY GILLYARD Owner 318-309-7720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2023-11-09 |