| NPI | 1053061317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA SIEG Owner 817-668-0513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 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 | 2022-03-28 |
| Last Update Date | 2024-04-30 |