| NPI | 1811341902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVON J SUPERVILLE President 940-632-6844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 33636) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 33636) |
| 251S00000X (Licence: TX 33636) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2018-07-31 |