| NPI | 1497107106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAQUI RENEE OTTO Psychologist 817-492-5105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |