| NPI | 1013730134 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNY PETTY Ownership Member 512-585-8468 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2024-11-06 |
| Last Update Date | 2025-01-29 |