| NPI | 1104299767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEELA JACKSON Licensed Clinical Psychologist 267-273-8041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017033) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2015-11-04 |