| NPI | 1982417473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GIDGETT BATES Owner 940-257-8388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QU0200X Clinic/Center, Urgent Care | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2026-02-25 |