| NPI | 1437713062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTIN ANCONA Ph.D 214-662-1791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-04-29 |
| Last Update Date | 2019-10-09 |