| NPI | 1467630608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYKEISHA P. SIMS Administrator 512-334-2149 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX F5318) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 26883) |
| 1041C0700X Social Worker, Clinical (Licence: TX 34223) | |
| 225100000X Physical Therapist (Licence: TX 1132165) | |
| Enumeration Date | 2008-02-08 |
| Last Update Date | 2012-10-22 |