| NPI | 1205686177 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ELLIS CEO 762-231-5806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-03-25 |
| Last Update Date | 2024-03-25 |