| NPI | 1003574468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE LANGFORD Credentialing 940-300-5077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2025-04-01 |