| NPI | 1285206656 |
|---|---|
| Doing Business As | SHATTERED 2 RESTORED |
| Entity Type | Organization |
| Authorized Contact | CHENEL M. STEWART Owner/Clinician 270-875-2548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |