| NPI | 1790179091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY S HEAPS Counselor 4358-628-6112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 6253891-3501) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2016-03-15 |