| NPI | 1801738307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA SISCO Owner/Manager/Provider 479-888-8234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2026-04-06 |
| Last Update Date | 2026-04-06 |