| NPI | 1871053843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIRGINIA IVES Owner/Provider 214-538-6565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2022-05-19 |