| NPI | 1760064067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL PETERSON Therapist 682-438-7154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-04-26 |
| Last Update Date | 2021-04-26 |