| NPI | 1194321729 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AUDREY CROUCH Owner 469-297-0682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2021-10-04 |