| NPI | 1649641119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON WATERS-BLAND Owner 817-894-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 53730) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 61178) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2015-10-09 |