| NPI | 1952784647 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN DALE PHILLIPS Licensed Professional Counselor 225-278-6178 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: LA 5379) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2015-07-13 |