NPI | 1033601661 |
---|---|
Former Name | IRENE ISLAS GOMEZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 117328) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 117328) |
Enumeration Date | 2018-05-30 |
Last Update Date | 2021-07-09 |