| NPI | 1366022501 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI NICHOLSON Owner/Director 682-463-1012 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2021-04-12 |