Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY23051 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY23051 | CA |
N | 103TH0004X | Health Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1134454663 |
---|---|
Provider Name | Jonathan Sills |
First Address | Palo Alto, CA 94304-1207 |
Second Address | Palo Alto, CA 94304-1207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2009 |
Last Update Date | 16/10/2009 |