| NPI | 1235634825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 1939) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 14315) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: TX 14315) | |
| 101YM0800X Counselor Mental Health (Licence: TX 80132) | |
| 106H00000X Marriage & Family Therapist (Licence: TX 203249) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-01-15 |