| NPI | 1104035385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MI 6401003770) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6401003770) |
| 101YM0800X Counselor, Mental Health (Licence: MI 6401003770) | |
| 101YP2500X Counselor, Professional (Licence: MI 6401003770) | |
| 103T00000X Psychologist (Licence: MI 6301009941) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: MI 6301009941) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301009941) | |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301009941) | |
| 103TC1900X Psychologist, Counseling (Licence: MI 6301009941) | |
| 103TF0000X Psychologist, Family (Licence: MI 6301009941) | |
| 103TF0200X Psychologist, Forensic (Licence: MI 6301009941) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301009941) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: MI 6301009941) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |