| NPI | 1881299675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY LUCAS LEWALLEN Owner 870-926-5710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2023-06-29 |