| NPI | 1649866203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN EDWARD COLLIER Authorized Official 731-426-3464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2022-05-27 |