| NPI | 1871813717 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA OVALETTE BODEN Owner 318-681-9935 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2023-06-21 |