| NPI | 1295193670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KORY STOTESBERY President 925-322-0418 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health (Licence: CA 20A12798) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health (Licence: CA 20A12798) |
| Enumeration Date | 2016-02-01 |
| Last Update Date | 2016-02-01 |