| NPI | 1598524084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES RANDALL ALLEN Owner 458-245-6948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2024-03-18 |