| NPI | 1154970085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE C MCDONALD Clinical Director 214-763-9595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0000X Psychologist Family | |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2020-05-11 |