| NPI | 1962755017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE BLUE Medical Staff Credentialing 214-645-7811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: TX 36320) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: MI 6301014547) |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2012-10-25 |