| NPI | 1639354046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERYL R JACKSON Psychologist 817-909-7995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 33305) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TX 33275) |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2008-01-03 |