| NPI | 1518647627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES ROBERT FULLER Owner 979-777-5545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2023-09-20 |