| NPI | 1477283562 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTEL L LONG Owner 214-881-8985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QI0500X Clinic/Center, Infusion Therapy |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 364SP0810X Clinical Nurse Specialist, Psych/Mental Health, Child & Family | |
| Enumeration Date | 2022-06-13 |
| Last Update Date | 2022-10-16 |