Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist |
NPI | 1427554732 |
---|---|
Provider Name | Kelsey Novak |
First Address | Mesa, AZ 85209-6216 |
Second Address | Mesa, AZ 85209-6216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 30/08/2019 |