| NPI | 1679086417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA GRUBBS Behavior Analyst 818-483-6630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY27372) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1-13-13840) |
| 103T00000X Psychologist (Licence: CA PSY27372) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY27372) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CA PSY27372) | |
| 103TS0200X Psychologist School (Licence: CA PSY27372) | |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2017-11-15 |