| NPI | 1356655112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA BRYN SIEGEL Lpc 972-400-0487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 63713) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2010-08-03 |