| NPI | 1922500099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALBERT L CRUMP Owner 573-514-3951 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2026-07-12 |