| NPI | 1134685746 |
|---|---|
| Former Name | LYSSA JEWEL IKERD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61102421) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60905925) |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2020-12-03 |