| NPI | 1952673915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANNELL ROBERTS Owner 601-255-5264 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MS 47821) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MS 1-11-9207) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MS 47821) | |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2018-09-07 |