Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY30102 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY30102 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY30102 | CA |
N | 103TF0000X | Family Psychologist | PSY30102 | CA |
N | 103TF0200X | Forensic Psychologist | PSY30102 | CA |
N | 103TP2701X | Group Psychotherapist | PSY30102 | CA |
NPI | 1053836445 |
---|---|
Provider Name | James Charles Husen |
First Address | Riverside, CA 92501-2325 |
Second Address | Riverside, CA 92501-2325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2017 |
Last Update Date | 01/04/2019 |