| NPI | 1083075790 |
|---|---|
| Former Name | KELLY SHIELDS-DIDEHBANI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OR C3406) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OR C3406) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2024-01-03 |