| NPI | 1669825766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD KIRK HENDERSON Owner 985-722-6219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 6088) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-07-13 |