| NPI | 1366101768 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN LOGIE Authorized Signature 667-662-2219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2021-12-13 |