| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 101YP1600X Counselor, Pastoral |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health |
| 103K00000X Behavior Analyst |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TB0200X Psychologist, Cognitive & Behavioral |
| 103TC1900X Psychologist, Counseling |
| 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TF0000X Psychologist, Family |
| 103TP2701X Psychologist, Group Psychotherapy |
| 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2012-01-04 |