| NPI | 1619695459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENA MILLER Director 479-483-3623 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-08-18 |