| NPI | 1578737193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY A LOGAN Provider/General Manager 210-615-0555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 23696) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2010-04-09 |