| NPI | 1881055507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AYNSLEY LUCKETT DOYLE Owner 318-880-8711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2023-06-28 |