| NPI | 1952800658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRYSTAL FULLEN Sole Member 210-410-3710 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 71964) |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2018-02-08 |