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TENDERLY REAY LOGAN PPSC; LEP; APCC

School >> Psychologist >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1972273787

Individual Registrant:
 TENDERLY REAY LOGAN PPSC; LEP; APCC
Gender: F
Not Sole Proprietor

Location and contact information for practice:
675 CLOVER VALLEY RD  UPPER LAKE, CA 95485-9220 US
Tel: 707-275-2338  Fax: --

Contact information for business:
675 CLOVER VALLEY RD  UPPER LAKE, CA 95485-9220 US
Tel: 707-275-2338  Fax: --

Registration Information:
NPI: 1972273787
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103TS0200XBehavioral Health & Social Service Providers
Psychologist
School
CA3183

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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