| NPI | 1245674829 |
|---|---|
| Former Name | LAURA J COSTELLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LMFTLF60805478) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60527932) |
| 106H00000X Marriage & Family Therapist (Licence: LF60805478) | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2018-10-23 |