| NPI | 1053996801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FARYN HENDERSON Owner 469-491-0820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2021-03-12 |