| NPI | 1285111302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LANEY ELIZABETH KNOWLTON Co Owner 682-216-6523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 202337) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 5160) |
| Enumeration Date | 2018-07-21 |
| Last Update Date | 2018-07-21 |