| NPI | 1245779362 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401017639) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2022-02-10 |