| NPI | 1225866114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY GLAVESKAS Credentialing Supervisor 214-550-7536 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2024-07-23 |