| NPI | 1881091684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY MICHELLE LOTT Administrator 409-622-9252 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX 3801-3802) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: TX 3801-3802) |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2021-11-29 |