NPI | 1053847111 |
---|---|
Former Name | KYLIE JEAN KELLAS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CA 92818) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 120845) |
106H00000X Marriage & Family Therapist | |
Enumeration Date | 2017-05-11 |
Last Update Date | 2023-10-23 |