| NPI | 1588036370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE B COSGROVE Credentialing 682-209-5662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 33494) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2019-04-04 |