| NPI | 1649744228 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARAH JO MATHEWS Owner 270-861-0606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 1041C0700X Social Worker, Clinical | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2019-01-16 |
| Last Update Date | 2024-05-30 |