| NPI | 1760921399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFERY BAFUS Counselor 903-309-0476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA LF60496366) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2017-02-15 |