| NPI | 1679864318 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAN RICHARD GRAHAM Owner/Executive Director 817-812-3021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 65237) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 65237) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2012-04-12 |