| NPI | 1730694373 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL LEE DERRER Owner 267-225-7402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: PA MF00059) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2017-12-05 |