| NPI | 1043994478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGARET HENSLEY KHOSHABA Co Owner 872-267-2427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-12-18 |