| NPI | 1396151700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN D GIFFORD Owner 817-858-6745 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 2-2020) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 36622) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2014-07-07 |