| NPI | 1144767450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI ANN MANNON Clinical Director 817-618-3705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 37383) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 73090) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2018-05-09 |