| NPI | 1003197658 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: UT 12966150-25801) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MI 6301014858) |
| 1041C0700X Social Worker, Clinical (Licence: UT 12966150-2501) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2024-04-02 |