| NPI | 1154628634 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA KELLISON Clinical Psychologist 707-364-9388 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 19863) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2011-02-18 |