NPI | 1083134472 |
---|---|
Former Name | KAITLYN HUMPHREY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2001815-SUPV) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1800888) |
Enumeration Date | 2017-06-27 |
Last Update Date | 2023-06-20 |