| NPI | 1821827155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MASON TODD HESTER Director 662-586-8081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-07-26 |
| Last Update Date | 2024-11-14 |