| NPI | 1457870057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA KIDD Managing Member 817-513-1415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2022-07-21 |