| NPI | 1801315866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOPHIA CANNON Director Of Clinical Services 469-986-9629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: TX 00230818) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2022-07-21 |