| NPI | 1740836303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER CUSACK COO 818-960-6830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 102L00000X Psychoanalyst | |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| 103TC0700X Psychologist, Clinical | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2019-08-09 |