| NPI | 1144724881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINAL GENE NELSON Owner 484-516-8142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS015506) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2018-03-19 |