| NPI | 1053848093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON MCNEW Practice Administrator 817-200-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2021-09-02 |