| NPI | 1215644133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN DEFEO Owner 541-699-1083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2022-10-31 |
| Last Update Date | 2022-10-31 |