| NPI | 1871101014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA LOPEZ-LARSON Owner/Provider 385-441-3004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2020-07-14 |