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 |