| NPI | 1104859859 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 33405) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: LA 410) |
| 103TC0700X Psychologist, Clinical (Licence: NM 642) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2008-02-25 |