| NPI | 1699406132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTAINY A WAGNER Billing Specialist 903-213-1005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 364SP0808X Clinical Nurse Specialist, Psych/Mental Health |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2024-09-25 |