| NPI | 1861875908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY JO SHOUP Owner 931-215-6863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: TN 14516) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: TN 14516) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-07-07 |