NPI | 1346757762 |
---|---|
Former Name | TIERRA YOUNGBLOOD |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401017826) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MI 4101006746) |
106H00000X Marriage & Family Therapist (Licence: MI 4101007120) | |
Enumeration Date | 2018-01-08 |
Last Update Date | 2024-05-15 |