| NPI | 1679195036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY ETHERIDGE Chief Operating Office 731-352-7907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2024-06-17 |