| NPI | 1164223699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS LOUALLEN Chief Executive Officer 667-392-6162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2025-03-21 |
| Last Update Date | 2025-05-19 |