| NPI | 1407426638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN HIGINBOTHAM Owner 310-713-5026 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2021-06-29 |