| NPI | 1811423486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA TIARA FULTON Owner, Administrator 907-306-4173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: AK 101114) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2017-05-02 |