| NPI | 1912214792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY JEROME WOOD Owner 662-772-5937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MS 1326) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 2251P0200X Physical Therapist, Pediatrics | |
| 225X00000X Occupational Therapist | |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2022-02-24 |