| NPI | 1891084414 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIMEE M TISDALE Program Director 228-806-9936 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TS0200X Psychologist, School | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2011-04-04 |