| NPI | 1114801404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIDAN NEAL Manager Credentialing 469-895-3411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-08-01 |
| Last Update Date | 2025-08-14 |