Organization Name: | TELECONNECT THERAPIES |
NPI Number: | 1871738112 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAWN MARIE SAMPSON (PARTNER) |
Mailing Address: | 22 Canyon Terrace Avalon |
State: | CA US |
Postal Code: | 90704 |
Phone Number: | 3108502960 |
Fax Number: | |
NPI Enumeration Date: | 12/15/2008 |
NPI Last Update Date: | 04/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY21275 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |