| NPI | 1962737759 |
|---|---|
| Former Name | ALICIA DAWN BUNTEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA psy23519) |
| 103TH0004X Psychologist, Health | |
| 103TF0000X Psychologist, Family | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities | |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2009-10-12 |
| Last Update Date | 2018-12-12 |