| NPI | 1306662010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE OMOTAYO Owner 469-414-2615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2024-11-26 |
| Last Update Date | 2025-07-04 |