| NPI | 1164694006 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: MI 6301012014) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: MI 6301012014) |
| 103TC1900X Psychologist Counseling (Licence: MI 6301012014) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: MI 6301012014) | |
| 103TH0004X Psychologist Health (Licence: MI 6301012014) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MI 6301012014) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2012-06-06 |