| NPI | 1992152763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARENCE CALVIN Behavioral Health Professional 318-218-0564 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2016-05-20 |