| NPI | 1477809689 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALCOLM ANDREW BEREAN Lmft 209-327-0588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CA 38325) |
| Additional Taxonomies | 251S00000X (Licence: CA 38326) |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2012-07-25 |