| NPI | 1235787821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI M COFFMAN CEO 951-900-4414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2024-09-07 |