| NPI | 1831631472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARTHA ROSE Owner 817-653-5888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: TX 36721) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 36721) |
| 102L00000X Psychoanalyst (Licence: TX 36721) | |
| 103TC0700X Psychologist Clinical (Licence: TX 36721) | |
| 103TF0000X Psychologist Family (Licence: TX 36721) | |
| 103TF0200X Psychologist Forensic (Licence: TX 36721) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: TX 36721) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 36721) | |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2017-05-01 |