| NPI | 1801609128 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD PARKER Agent 662-620-7102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist | |
| Enumeration Date | 2025-01-30 |
| Last Update Date | 2025-01-30 |