NPI | 1154531069 |
---|---|
Former Name | TYANNE LANEE HAMPTON CLANCY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39002335A) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2007-05-23 |
Last Update Date | 2020-12-02 |