| NPI | 1912645961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AL BERRY Manager 469-915-4211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-05-20 |
| Last Update Date | 2024-12-19 |