| NPI | 1851341747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE ANTHONY HOOVER Chief Executive Officer 4127-822-3510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA 001741210) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2017-04-04 |