| NPI | 1568883858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN LOREN PEMBERTON Psychiatric Nurse Practioner 817-416-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health (Licence: TX 590614) |
| Enumeration Date | 2014-01-03 |
| Last Update Date | 2014-01-03 |