| NPI | 1700572237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE BROCKMAN Counselor 737-232-7439 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| 251S00000X | |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2023-04-17 |