| NPI | 1841696101 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTIS T JACKSON CEO/President 901-207-4662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: TN 1000000015105) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: TN 1000000015105) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: TN 1000000015105) | |
| 251S00000X (Licence: TN 1000000015105) | |
| Enumeration Date | 2014-11-14 |
| Last Update Date | 2014-11-14 |