| NPI | 1720639958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY RAMIREZ Billing & Credentialing Manager 541-500-8655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2019-09-29 |
| Last Update Date | 2019-11-24 |