| NPI | 1194421172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN NKOTANYI Administrator 817-404-3365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2023-02-01 |