| NPI | 1295310001 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE STARK Manager And Licensed Psychologist 817-917-7348 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2021-03-12 |
| Last Update Date | 2022-09-03 |