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 |