| NPI | 1952859167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANNE MBAI Manager 817-350-4377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP124647) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2021-05-31 |