| NPI | 1104348937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VANESSA E FAJARDO Licensed Professional Counselor 469-713-2413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2017-07-13 |