| NPI | 1184396541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SELENE HAMMON President 682-269-9889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2022-06-01 |