NPI | 1760736953 |
---|---|
Former Name | TRACY LYNNE HIGH |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 17424) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY17424) |
Enumeration Date | 2012-11-09 |
Last Update Date | 2020-02-13 |