| NPI | 1902792641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVANLEA CHANEY Lac 501-908-5187 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-06-17 |