NPI | 1063296747 |
---|---|
Former Name | JORDAN L KOONTZ |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2023042180) |
Enumeration Date | 2023-08-23 |
Last Update Date | 2025-01-14 |