| NPI | 1316463847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI BILLMAN Claims Manager 817-470-6676 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 22365) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 22365) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2018-05-31 |