| NPI | 1386103257 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR CHARLES DRAKE Manager 951-640-1276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2019-03-19 |