| NPI | 1043845662 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA PT30000) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PT30000) |
| 103TH0100X Psychologist, Health Service (Licence: CA PT30000) | |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2020-03-05 |