| NPI | 1124566245 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA MCKELVY Psychologist 817-891-6626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 37380) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-09 |