| NPI | 1295147023 |
|---|---|
| Former Name | GENNIE LEE RUSSELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: UT 74547942506) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 74547943501) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2018-11-12 |