| NPI | 1134676802 |
|---|---|
| Former Name | KYLIE NICOLE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: TX 70475) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2022029205) |
| 101Y00000X Counselor (Licence: CO 0017923) | |
| Enumeration Date | 2016-09-09 |
| Last Update Date | 2022-08-01 |