| 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 |
| Enumeration Date | 2024-04-04 |
| Last Update Date | 2024-09-04 |