| NPI | 1629320478 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID J CUDMORE Director Of Development 817-338-0311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: TX 1656-3039) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: TX 1656-3039) |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX 1656-3039) | |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2022-07-21 |