| NPI | 1356580146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TX LCSW00383) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TX LPC00791) |
| 101YM0800X Counselor Mental Health (Licence: TX LCSW0383) | |
| 101YP2500X Counselor Professional (Licence: TX LPC00791) | |
| 106H00000X Marriage & Family Therapist (Licence: TX LMFT00561) | |
| 102L00000X Psychoanalyst (Licence: TX LCSW0383) | |
| 104100000X Social Worker (Licence: TX LCSW0383) | |
| 103K00000X Behavior Analyst (Licence: TX LCSW0383) | |
| 101YM0800X Counselor Mental Health (Licence: TX LCSW00791) | |
| 106H00000X Marriage & Family Therapist (Licence: TX LPC00791) | |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2009-07-21 |