| NPI | 1891547626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI NOLEN Business Manager 682-472-2869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 251B00000X Case Management | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 322D00000X Residential Treatment Facility, Emotionally Disturbed Children | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2025-01-27 |