| NPI | 1770359598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER GUTIERREZ Provider Relations 909-289-4075 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 104100000X Social Worker |
| 106H00000X Marriage & Family Therapist | |
| 103T00000X Psychologist | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2023-12-01 |
| Last Update Date | 2023-12-01 |