| NPI | 1104433986 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK BACB587693) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OK BACB587693) |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2025-08-19 |