| NPI | 1598108912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK J INGRAM Psychologist/CEO 424-271-2933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 24268) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 24268) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2024-02-12 |