| NPI | 1114316692 |
|---|---|
| Former Name | ELLIE FELLBAUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 76240) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2020-05-13 |