| NPI | 1710124516 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVONNA M LATTA Office Manager 479-443-5575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0319P) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2009-01-15 |