| NPI | 1184498669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL POLLY Provider 940-767-2914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2023-11-17 |