| NPI | 1487107694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERNON C JOHNSON Owner 903-814-5435 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2016-07-25 |