| NPI | 1093530230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARLA EIDSON Authorized Official 979-218-1068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-11-21 |
| Last Update Date | 2024-11-21 |