| NPI | 1386780336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NAT MANGUM CEO 469-688-6628 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX J1957) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 15980) |
| 101YP2500X Counselor Professional (Licence: TX 20025) | |
| 101YP2500X Counselor Professional (Licence: TX 17173) | |
| 103T00000X Psychologist (Licence: TX 21357) | |
| 225100000X Physical Therapist (Licence: TX 1030278) | |
| 225100000X Physical Therapist (Licence: TX 1014587) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2009-04-22 |