| NPI | 1821879156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANN WILSON Director 662-303-1800 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-12 |