| NPI | 1609569177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSALINDA LOGAN Revenue Cycle Analyst 731-935-9267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251B00000X Case Management | |
| Enumeration Date | 2023-05-31 |
| Last Update Date | 2023-05-31 |