| NPI | 1740007129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL KHOURY CFO 662-432-2995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2024-09-25 |
| Last Update Date | 2024-09-25 |