| NPI | 1134731813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY C JOHNSON Owner 469-825-0414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TH0100X Psychologist, Health Service | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2020-08-23 |
| Last Update Date | 2020-08-23 |