| NPI | 1780393991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAKEISHA TAYLOR GOSTON Dr. Jakeisha Taylor Goston, Ap RN 662-721-2304 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-11-16 |
| Last Update Date | 2022-11-16 |