| NPI | 1104540079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIE MICHELLE CLARK Member/Owner 817-691-9968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 208000000X Pediatrics | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-11-05 |