| NPI | 1952097131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSAYANDE ALFRED-IYAMU Director 469-450-7164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2025-05-22 |