| NPI | 1134582612 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM CCMH0207031) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YM0800X Counselor Mental Health (Licence: NM CCMH0207031) | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2023-11-15 |