| NPI | 1922354349 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA WOLTER Provider Enrollment Rep 909-651-4352 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 104100000X Social Worker |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2012-08-03 |