| NPI | 1184644395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE WALLACE Mft 661-205-1522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA MFC 40616) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2008-08-08 |