| NPI | 1972207074 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH WAYLON DABBS Supervisor 270-784-5003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251B00000X Case Management |
| 251S00000X | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2023-03-30 |