| NPI | 1265405419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIA J SHEARMAN Credentialing Specialist 531-355-8104 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2024-07-25 |