| NPI | 1629456173 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY PAUL BLACKBURN Owner/Manager 903-462-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 56023) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2015-05-15 |