| NPI | 1063574499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN CHRISTENSON Provider Enrollment Services 979-492-2795 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| 103TC1900X Psychologist Counseling | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2024-05-02 |