| NPI | 1851042238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOUJANYA PULLURU Owner 479-204-1258 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 231H00000X Audiologist | |
| 101YM0800X Counselor, Mental Health | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2022-01-17 |