NPI | 1205271822 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 6301015252) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 6301015252) |
103T00000X Psychologist (Licence: MI 6301015252) | |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: MI 6301015252) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MI 6301015252) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: MI 6301015252) | |
103TP2701X Psychologist, Group Psychotherapy (Licence: MI 6301015252) | |
103TS0200X Psychologist, School (Licence: MI 179302) | |
104100000X Social Worker (Licence: MI 6801013804) | |
1041C0700X Social Worker, Clinical (Licence: MI 6801013804) | |
Enumeration Date | 2013-05-09 |
Last Update Date | 2013-05-09 |