Behavioral Health & Social Service Providers (515) PERSON CLASS (8932.1)

Name	Value
PROVIDER TYPE	Behavioral Health & Social Service Providers
CLASSIFICATION	Psychologist
AREA OF SPECIALIZATION	Educational
STATUS	Inactive
DATE INACTIVATED	2009-04-22 00:00:00
VA CODE	V010412
X12 CODE	103TE1000X
INDIVIDUAL/NON	INDIVIDUAL
MASTER ENTRY FOR VUID	YES
VUID	5252342
EFFECTIVE DATE/TIME	2018-04-02 15:35:47 STATUS: INACTIVE