| NPI | 1679288666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON LERACH Owner 619-817-5320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Enumeration Date | 2023-01-16 |
| Last Update Date | 2023-01-16 |