| NPI | 1144435249 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN M. WAGNER Managing Director 915-545-6664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103T00000X Psychologist |
| 106H00000X Marriage & Family Therapist | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-08-22 |