| NPI | 1114659307 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106S00000X Behavior Technician (Licence: WA CB61241743) | |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2026-01-06 |