| NPI | 1336651579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON SHESTOK Owner 512-998-9806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: TX 37124) |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2017-10-27 |