NPI | 1003683921 |
---|---|
Former Name | BRIANNA HOPE BRACKELSBERG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2023-12-11 |
Last Update Date | 2023-12-11 |