| NPI | 1235580556 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLY MARIE KETCHUM Lmft 949-391-1812 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CA LMFT81406) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2018-07-20 |