| NPI | 1770043747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MERCEDES QUEEN MCQUEEN Director 817-412-3956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 251S00000X | |
| 323P00000X Psychiatric Residential Treatment Facility | |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2019-03-24 |