NPI | 1053850636 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0017386) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 00529-LC) |
101YM0800X Counselor, Mental Health (Licence: NM CTB-2023-0648) | |
101YM0800X Counselor, Mental Health (Licence: AZ LPC-21334) | |
101YM0800X Counselor, Mental Health (Licence: MO 202234677) | |
101YM0800X Counselor, Mental Health (Licence: NV CP5078-R) | |
Enumeration Date | 2017-02-16 |
Last Update Date | 2025-08-11 |