| NPI | 1831220334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY LAMAR GRANT Mental Health Professional 870-245-2210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: AR p0607039) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-08-22 |