| NPI | 1780475707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIMIE LORENA HOLSTED Administrator 870-416-9901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2025-05-16 |
| Last Update Date | 2025-05-16 |