| NPI | 1013469923 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL CLINTON C TYSON Director Of Operations 209-769-3420 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical | |
| 103TC1900X Psychologist, Counseling | |
| 103TP0016X Psychologist, Prescribing (Medical) | |
| 103TP0814X Psychologist, Psychoanalysis | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 251S00000X | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2016-10-26 |