| NPI | 1760917785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORIE WIDMAN Practice Administrator 512-212-4670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 261QM0801X | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2021-07-26 |