| NPI | 1811475866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LESLEY J ROSS Owner/Therapist 731-608-6084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: TN 2093) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |