| NPI | 1285708388 |
|---|---|
| Former Name | AMANDA MCCULLOUGH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 18842) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 18842) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |