NPI | 1104639038 |
---|---|
Former Name | MATHILE L HORNBACK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0020585) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0020585) |
Enumeration Date | 2025-01-27 |
Last Update Date | 2025-04-24 |