| NPI | 1982417473 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GIDGETT BATES Owner 940-257-8388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2025-01-29 |
| Last Update Date | 2025-07-18 |