| NPI | 1942674825 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD MITCHELL Director 318-459-1600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2023-07-03 |