| NPI | 1619126497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WAYNE SUTTON Owner 817-293-1555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 19974) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: TX 61635) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2008-09-16 |