| NPI | 1760137061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIE LYNNE KEASLER Owner 573-872-4798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2022-11-21 |