| NPI | 1962824052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASEON OUTLAW Clinical Director/Owner 510-463-1302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY23676) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 53851) |
| Enumeration Date | 2014-01-09 |
| Last Update Date | 2014-01-09 |