| NPI | 1679923163 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELMITH MAMO Provider 469-618-5703 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX AP126843) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2017-02-20 |