| NPI | 1952189433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSALINDA LOGAN-PETERS Revenue Cycle Manager 731-935-9267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 171000000X Military Health Care Provider | |
| 171M00000X Case Manager/Care Coordinator | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-09-18 |
| Last Update Date | 2023-09-18 |