| NPI | 1679283915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA BAILEY Practice Administrator 270-442-3535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 363A00000X Physician Assistant | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2025-05-20 |