| NPI | 1619774411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM NESBITT Credentialing Specialist 870-269-1337 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-02-27 |
| Last Update Date | 2025-10-27 |