Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | A23729 | CA |
NPI | 1346687605 |
---|---|
Provider Name | John Terrance Hackett |
First Address | Delhi, CA 95340 |
Second Address | Delhi, CA 95315-8200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2013 |
Last Update Date | 15/03/2014 |