| NPI | 1871950170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAWRENCE MACK CEO 210-393-0763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 62743) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 62743) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2016-01-19 |