| NPI | 1902115082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DOUGLAS BREITHAUPT Licensed Clinical Psychologist 408-320-2747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY499) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI PSY499) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: HI PSY499) | |
| 106H00000X Marriage & Family Therapist (Licence: HI PSY499) | |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2019-09-09 |