| NPI | 1932883600 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIEKA EBON HARRIS Chief Executive Officer 662-404-1429 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-06-13 |
| Last Update Date | 2023-12-26 |