| NPI | 1083888507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 62024) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 62024) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 62024) | |
| 101YP2500X Counselor, Professional (Licence: TX 62024) | |
| 101YS0200X Counselor, School (Licence: TX 62024) | |
| 103G00000X Clinical Neuropsychologist (Licence: TX 62024) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: TX 62024) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: TX 62024) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: TX 62024) | |
| 103TC1900X Psychologist, Counseling (Licence: TX 62024) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: TX 62024) | |
| 103TF0000X Psychologist, Family (Licence: TX 62024) | |
| 103TH0100X Psychologist, Health Service (Licence: TX 62024) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: TX 62024) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 62024) | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2008-04-16 |