| NPI | 1922779065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH WARD Managing/Sole Member 915-201-0675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-09-27 |