| NPI | 1689123457 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RUSSELL Office Manager 254-968-4020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 70485) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2016-09-22 |