| NPI | 1235420811 |
|---|---|
| Former Name | SUSAN LAURA GENTZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC 000140) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA MFC 38572) |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2011-04-29 |