| NPI | 1023408341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRENCE WAGER Owner 971-400-5544 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OR 2220) |
| Enumeration Date | 2015-01-24 |
| Last Update Date | 2015-01-24 |