| NPI | 1699142026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL WILLIAMS Owner 318-245-3906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: LA 4367) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2023-06-29 |