| NPI | 1619508025 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC L FULLER Executive Director 469-216-5269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services |
| Additional Taxonomies | 347E00000X Transportation Broker |
| 261QD1600X Clinic/Center Developmental Disabilities | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| 305S00000X Point of Service | |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2020-02-04 |