| NPI | 1174990360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY R PEDERSON Owner 650-213-2133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY23743) |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2023-05-23 |