| NPI | 1912405242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK HARTLEY ELDER Counselor 210-326-4663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: TX 63638) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: TX 63638) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2018-02-01 |