| NPI | 1912736026 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKSON TEA CFO 626-429-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 1041C0700X Social Worker, Clinical | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2024-07-29 |
| Last Update Date | 2024-07-30 |