| NPI | 1366101768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN LOGIE Authorized Signature 667-662-2219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2026-05-05 |