| NPI | 1629565189 |
|---|---|
| Other Name | IMATTER OD WYATT |
| Entity Type | Organization |
| Authorized Contact | MISTY MOLINA Business Office Director 817-447-3001 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2018-04-19 |