| NPI | 1770060691 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAVEN MODISETTE CEO 817-695-5035 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: TX M9770) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: TX M9770) |
| 2084P0802X Psychiatry & Neurology Addiction Psychiatry (Licence: TX M9770) | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: TX M9770) | |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: TX M9770) | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: TX M9770) | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner Family (Licence: TX AP137299) | |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TX AP137299) | |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2020-04-04 |