| NPI | 1154144913 |
|---|---|
| Former Name | CAITLYN ANNE THELEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301019587) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6301019587) |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2024-12-19 |