NPI | 1124588900 |
---|---|
Former Name | ALICIA MANGRUM-NUSS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180003308) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180003308) |
Enumeration Date | 2019-03-20 |
Last Update Date | 2025-08-12 |