| NPI | 1700643921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TULA DESHA JEFFERSON Dnp 832-328-5460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-07-12 |