| NPI | 1184080046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA LPC8270) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 8270) |
| 101Y00000X Counselor (Licence: TX 99052) | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2026-03-26 |