| NPI | 1134712672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA SUZANN BAILEY Owner 907-646-2952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2021-02-16 |
| Last Update Date | 2024-04-29 |