| NPI | 1720571326 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY IMHOLTE Owner 512-431-3721 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 51195) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2018-06-16 |