| NPI | 1144576356 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE JACKSON Business Manager 512-638-2366 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 50146) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: TX 10476) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2012-07-25 |