| NPI | 1720775166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN GADDIS Owner 817-349-7646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-04-23 |