| NPI | 1093359259 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WY LPC-2089) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101Y00000X Counselor (Licence: WY PPC-1231) | |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2022-09-30 |