| NPI | 1568116002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER LONGORIA Co Owner 270-872-3540 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2022-02-03 |
| Last Update Date | 2023-11-17 |