| NPI | 1922367036 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY LANE GREEN Operating Manager 479-936-5944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2012-07-16 |