| NPI | 1770082745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK THOMAS BARISA Neuropsychologist 469-400-6230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: TX 34011) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: TX 34011) |
| 261QM0850X Clinic/Center Adult Mental Health (Licence: TX 34011) | |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: TX 34011) | |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2021-12-29 |