| NPI | 1275807216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY KRISTINE MCCOY Counselor 817-501-7098 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 68618) |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2012-03-07 |