| NPI | 1609203413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLIFTON HENRY FULLER Owner 210-970-1511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 299) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 9189) |
| 106H00000X Marriage & Family Therapist (Licence: TX 1081) | |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2023-08-22 |