NPI | 1992223291 |
---|---|
Former Name | HALEY MELISSA GORDON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY31276) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY31276) |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: PSY31276) | |
Enumeration Date | 2017-09-07 |
Last Update Date | 2023-09-05 |