| NPI | 1003358318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY MARIE AYALA Owner 318-840-5786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 66255) |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2016-11-17 |