NPI | 1003940560 |
---|---|
Entity Type | Organization |
Authorized Contact | STEVE R. WYSOCKI Clinical Psychologist 909-980-3567 |
Organization Subpart ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 6143) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 16794) |
106H00000X Marriage & Family Therapist (Licence: CA MFC 28102) | |
Enumeration Date | 2007-03-15 |
Last Update Date | 2009-03-04 |