| NPI | 1134685993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESI JENSEN Office Administrator 469-422-1262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2019-02-18 |