| NPI | 1952662157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILEE KENNEDY Billing Specialist 662-840-0974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Additional Taxonomies | 261QD1600X Clinic/Center Developmental Disabilities |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2016-07-15 |