| NPI | 1679956106 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN LATTA-CLARK Mental Health Clinic Supervisor 909-387-7385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CA ASW62959) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2015-07-01 |