| NPI | 1255111589 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN A FULLER Owner/President 682-360-9035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Enumeration Date | 2023-10-04 |
| Last Update Date | 2023-10-06 |