| NPI | 1962164509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAJE HENDRIX Owner 424-750-6140 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2021-10-15 |