| NPI | 1669888384 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICKEY L LEWIS Owner 270-776-4751 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 0348) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 1436) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2014-07-02 |