Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY19632 | CA |
Y | 103T00000X | Psychologist | PSY19632 | CA |
NPI | 1013136548 |
---|---|
Provider Name | Teresa Mcintyre-Harlow |
First Address | Diamond Springs, CA 95619-9173 |
Second Address | Diamond Springs, CA 95619-9453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 25/04/2011 |