| NPI | 1205214087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATY D GAINES CEO 323-456-8686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY26943) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY26943) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY26943) | |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY26943) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2018-11-20 |