| NPI | 1801832365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS WAYNE WILSON Owner 731-431-0609 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TN P0000001010) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2020-08-22 |