| NPI | 1649746660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN HARRELL Office Manager 662-510-8606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2024-06-21 |