| NPI | 1730706979 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA BURKE Executive Director 619-838-4874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2020-07-04 |
| Last Update Date | 2020-07-04 |