| NPI | 1407250798 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA TAYLOR WIGGINS Credentialing Agent 888-543-6349 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 18481) |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2015-06-25 |