| NPI | 1851964092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEFANIE MANLEY VP Of Strategic Development 469-640-2051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 103T00000X Psychologist |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2021-07-23 |