| NPI | 1275187080 |
|---|---|
| Former Name | THERESA ELIZABETH JORDAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ME CC6723) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OK 10200) |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2022-08-24 |