| NPI | 1174001879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL BAUER Licensed Clinical Psychologist 177-323-4806 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IL 071.009484) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2018-08-03 |