| 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 |