| NPI | 1922344068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOTTIE CALLOWAY Billing/It Director 662-822-2219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2012-12-18 |