| NPI | 1104450063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVYN P. HOWELL Nurse Practitioner 682-224-9655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2024-02-08 |