| NPI | 1265856769 |
|---|---|
| Former Name | MCKENZIE S FALLON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL 3494) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL C2219A) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2022-02-14 |