| NPI | 1831746767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LONG Office Manager 270-715-1178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2021-09-13 |