| NPI | 1457095986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED A DOEGEY Owner 909-276-7720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2026-02-26 |