| NPI | 1720484959 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KEITH WADE Owner 915-886-8793 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 68877) |
| Additional Taxonomies | 251S00000X (Licence: TX 68877) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2014-11-17 |