| NPI | 1215213186 |
|---|---|
| Former Name | KRYSTAL L HERGOTT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 1460) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 1402) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2018-08-30 |