| NPI | 1760852511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTNEY CUMMINGS Owner 318-861-8938 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2023-06-26 |