| NPI | 1508310293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOSES TABE AMBILICHU Md 972-974-0109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MO 2011019835) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2024-07-31 |