| NPI | 1316393192 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR MOODY Manager 832-930-4898 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 58768) |
| 2084N0400X Psychiatry & Neurology Neurology (Licence: TX Q4831) | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2019-06-23 |