| NPI | 1790861086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN LEE MURRAY-WACHTENDORF Director 936-931-3324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 63119) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: TX 63119) |
| 102L00000X Psychoanalyst (Licence: TX 63119) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 261QS1200X Clinic/Center, Sleep Disorder Diagnostic (Licence: TX 1983) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: TX 63119) | |
| 261QR0400X Clinic/Center, Rehabilitation (Licence: TX E6345) | |
| Enumeration Date | 2006-10-29 |
| Last Update Date | 2009-09-26 |