| NPI | 1841015104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EVELYN DERRY Licensed Mental Health Professional 318-208-0451 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2024-11-20 |
| Last Update Date | 2024-11-20 |