| NPI | 1740568872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES WESLEY QUILLIN President 318-442-7355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: LA 0318 MP) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: LA 0318MP) |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: LA 0318MP) | |
| 1041C0700X Social Worker, Clinical (Licence: LA 2498) | |
| 103TC0700X Psychologist, Clinical (Licence: LA 1288) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: LA 1288) | |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2014-11-26 |