| NPI | 1609566967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY BROCK Director Of Revenue 318-281-2448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2023-05-10 |