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Individual
MARK JOHN SOURIS
Active
Individual
MARK JOHN SOURIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY14283
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14283
LICENSE NUMBER
CA
Enumeration date
11/27/2007
Last updated
11/17/2016
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