| NPI | 1770719106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BESS GINTY CEO 870-633-1737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: AR 24585) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: AR 24585) |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2021-05-19 |