| NPI | 1124047295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUE FUCIARELLI Vice President For Finance And Admi 915-215-4300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 106H00000X Marriage & Family Therapist | |
| 183500000X Pharmacist | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-01-29 |