| NPI | 1275880445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDELL JASPER Owner 980-229-3788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TF0000X Psychologist, Family | |
| 103TP0814X Psychologist, Psychoanalysis | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 251S00000X | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2012-08-07 |