| NPI | 1164617007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDY LUDECKE BENCOSME Owner 626-701-4249 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 22818) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA MFC38430) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2015-06-08 |