NPI | 1194223156 |
---|---|
Former Name | JENNA LYNN KELLEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: NC 2149) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 12059A) |
Enumeration Date | 2018-01-24 |
Last Update Date | 2020-07-22 |