| NPI | 1699854836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA L BRUCATO Program Manager 270-943-1851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2011-12-14 |