| NPI | 1891587556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN SIMMONS Owner 580-541-9792 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2025-05-20 |
| Last Update Date | 2025-05-20 |