| NPI | 1215336391 |
|---|---|
| Former Name | TARA SUPLICKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 5701) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 5701-125) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2017-08-22 |