| NPI | 1396469078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN LOSHUN MOON Lpc A 254-383-8499 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2022-09-27 |