| NPI | 1972938769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE LEJEUNE BULLER Owner 225-663-0205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 11837) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2013-09-11 |