| NPI | 1720481021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUANITA STOUT Program Director 396-257-8189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 3769-3770) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2014-09-30 |