| NPI | 1255963955 |
|---|---|
| Former Name | BETHANY JANE BRUNELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 65041) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX 65041) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 15499) | |
| 104100000X Social Worker (Licence: TX 65041) | |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2022-12-15 |