| NPI | 1982836250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID CUDMORE Director Of Development 817-338-0311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: TX 1656-A) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX 1656-A) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2021-10-19 |