| NPI | 1720469570 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER BUBOLTZ Psychologist 318-512-9637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: LA 870) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2015-06-17 |