| NPI | 1588286793 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRALICA CLEWIS Credential/Billing 469-586-7643 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-08-30 |