| NPI | 1104415405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN N MBUGUA Mental Health Nurse Practitioner 214-458-1713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-01-25 |