| NPI | 1639869688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TATIANA VUKOTIC Chief Executive Officer 872-808-0068 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TH0100X Psychologist, Health Service | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2023-05-12 |
| Last Update Date | 2023-05-12 |