| NPI | 1750655296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TROY J. EWING CEO 916-482-6469 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TC0700X Psychologist Clinical | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0200X Psychologist Forensic | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities | |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2013-03-27 |