| NPI | 1962072041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL ADAM BAXTER Owner 817-697-4777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2024-02-09 |