| NPI | 1710169503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBORAH LYNN DOUBLIN Administrator 318-325-8748 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2023-06-15 |