| NPI | 1710474077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH R MEDLOCK Chief Executive Officer 469-879-8328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2018-04-21 |
| Last Update Date | 2018-08-17 |