| NPI | 1336537745 |
|---|---|
| Former Name | PHETSAVANH KEOBOUAVANH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180010325) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: IL 1001080) |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2020-10-13 |