| NPI | 1811730336 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY STALEY Billing Director 512-270-1286 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2024-06-13 |