| NPI | 1700334604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON NORTHRUP Co Owner, Manager 210-833-4011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 61536) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2021-08-31 |