| NPI | 1245472562 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WY 412) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY LPC-412) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2012-05-24 |