NPI | 1225432925 |
---|---|
Former Name | SUSAN MARIE KIMMELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60903058) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60942001) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60942001) | |
Enumeration Date | 2014-10-09 |
Last Update Date | 2023-08-04 |