| NPI | 1932742988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MACHELLE DOUGLASS Pmhnp 662-420-1532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-10-22 |
| Last Update Date | 2020-01-02 |