| NPI | 1164957445 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 79836) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 79836) |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2025-01-06 |