| NPI | 1891423687 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAZEDRICK R LOGAN Owner Of Entity 800-909-7140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-08-10 |
| Last Update Date | 2024-02-16 |