| NPI | 1902579675 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD LANIER Office Manager 817-602-4389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2024-07-15 |