| NPI | 1154728566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANDY JO JORDAN Clinical Psychologist 817-916-8200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 34438) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-01 |