| NPI | 1154502391 |
|---|---|
| Former Name | JOLENE MARIE NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH 60429987) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2014-09-23 |