| NPI | 1063042851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY DE HESA Executive Director 909-420-0413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2020-01-21 |