| NPI | 1548961550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRALICA CLEWIS Credential Coord 469-586-7643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-03-15 |
| Last Update Date | 2023-06-09 |