| NPI | 1649651324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREBOR WELLINGTON BOSLEY Clinical Director 405-535-1048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2015-06-17 |