| NPI | 1073533253 |
|---|---|
| Former Name | ANGELA SUSAN PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 3582) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 19763) |
| 1041C0700X Social Worker, Clinical (Licence: TX 19763) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2021-07-08 |