| NPI | 1649953498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATRINA M CANADY Owner 915-213-4656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251S00000X | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2025-02-20 |