| NPI | 1053639088 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MS R883581) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MS 1360) |
| 106H00000X Marriage & Family Therapist (Licence: MS T0434) | |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2012-09-19 |