| NPI | 1962638890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY PINE Owner 951-240-5250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP1600X Counselor, Pastoral | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2009-06-05 |