| NPI | 1831756303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN RICHARDSON Managed Care Coordinator 817-873-0595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2026-01-05 |