| NPI | 1700316296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSE TUCKER Owner 817-478-5333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2024-09-04 |