| NPI | 1679128367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY ANDREW FUSCO Owner/Founder/Psychotherapist 469-496-5695 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 251S00000X |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2023-09-06 |