| NPI | 1275932014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CAAR.CG.60500645) |
| 101YP2500X Counselor Professional | |
| 3104A0625X Assisted Living Facility Assisted Living, Mental Illness (Licence: WA CAAR.CG.60500645) | |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: WA CAAR.CG.60500645) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2019-03-08 |