| NPI | 1609621143 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTAINY A WAGNER Biller And Credentialer 903-213-1005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-04-18 |
| Last Update Date | 2024-09-25 |