| NPI | 1063092716 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY ERVIN THOMASON Co Owner 903-336-3484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2021-04-08 |