| NPI | 1629009295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFFER LEE SHOWALTER Executive Assistant 223-465-2025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2023-03-29 |