| NPI | 1558661041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN A. BOURKE Owner/President 209-384-8808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 16571) |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health (Licence: CA PSY 16571) |
| Enumeration Date | 2010-10-30 |
| Last Update Date | 2011-03-23 |