NPI | 1265818801 |
---|---|
Former Name | TESSA LEE IACONO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 1202) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-10403) |
Enumeration Date | 2015-08-05 |
Last Update Date | 2015-08-05 |