| NPI | 1023409372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALEIGH PETTIS Clinical Therapist 951-522-0730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA mg 60493139) |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2015-02-09 |