| NPI | 1932979002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LONELL GUNN Clinician Non Licensed 731-506-9012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-08 |