| NPI | 1780361725 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS C PETERSON Owner 662-769-2331 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-06-30 |
| Last Update Date | 2023-06-30 |