| NPI | 1144757865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE TUCKER Owner 817-478-5333 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-05-12 |
| Last Update Date | 2018-03-17 |