| NPI | 1750827499 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY WUTZKE Clinical Psychologist 858-413-7557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY17239) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 52458) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2021-11-14 |