| NPI | 1992423776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN CHRISTENSON Provider Enrollment Specialist 979-492-2795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2022-08-18 |