| NPI | 1528598620 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNE LAVIN Provider/Owner 210-441-1074 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: TX 33606) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX 3587) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2017-08-17 |