| NPI | 1962752626 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD POWELL Administrator 730-242-6333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS1000X Clinic/Center Student Health |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2012-09-10 |