| NPI | 1316340680 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY11004) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103TH0100X Psychologist Health Service (Licence: MI 6301017240) | |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2021-07-12 |