| NPI | 1548513195 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN D STARK Director 512-324-3315 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 36256) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2012-10-19 |