| NPI | 1861789331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMIE BLACKBURN Medical Billing 580-357-3034 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2011-07-06 |