Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY 18041 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 18041 | CA |
NPI | 1003086885 |
---|---|
Provider Name | Dr. John Bradley Lumpkin |
First Address | Coalinga, CA 93210-8500 |
Second Address | Coalinga, CA 93210-8500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2008 |
Last Update Date | 07/03/2008 |