| NPI | 1376631713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY SHAFFER TATE Owner Clinical Psychologist 937-435-8864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 4664) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2011-06-29 |