| NPI | 1780146415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LEA GLENN Licensed Clinical Social Worker 469-759-3966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2019-04-02 |