| NPI | 1790210805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMPA YVETTE GIPSON Mental Health Specialist 318-990-8276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2017-04-26 |