| NPI | 1720202500 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | C WESLEY JACKSON President Owner 216-321-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH 474) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 000519) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2012-07-30 |