| NPI | 1003956574 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: KY 168204) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY 104984) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2018-05-08 |