| NPI | 1144001801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUKE ANTHONY HUMPHREY Owner 951-365-4678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2023-10-09 |