| NPI | 1821131673 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTINE ANNE PETRIE President 714-990-0700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist Prescribing (Medical) (Licence: CA C38832) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA PSY6172) |
| 101YM0800X Counselor Mental Health (Licence: CA PSY15282) | |
| 106H00000X Marriage & Family Therapist (Licence: CA ML012201) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2015-03-26 |