| NPI | 1942375605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL JOHN SHEPERIS Clinical Director 662-648-9829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MS 832) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-08-22 |