| NPI | 1992993521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JB WILLIS Owner 318-377-2233 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 2155 LPC 69-LMFT) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2007-10-09 |