| NPI | 1023473923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: TX 69981) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor Mental Health | |
| 101YS0200X Counselor School | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker Clinical | |
| 251B00000X Case Management | |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2015-12-18 |
| Last Update Date | 2024-07-02 |