| NPI | 1316580681 |
|---|---|
| Former Name | BREANNE MONTGOMERY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CO 6225) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AZ 17649) |
| Enumeration Date | 2019-10-19 |
| Last Update Date | 2021-04-05 |