| NPI | 1275880023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANI SUZANNE TRENT Licensed Clinical Psychologist & 10 681-238-5600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WV 1027) |
| Enumeration Date | 2012-08-11 |
| Last Update Date | 2023-08-10 |