| NPI | 1902322233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY WESTON Program Mgr 318-517-7541 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: LA 2203783449) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: LA 2203783449) |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2018-01-04 |