| NPI | 1356619159 |
|---|---|
| Former Name | JETTA LEE SULLIVAN-WELLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO MFT.0001459) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 48536) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2023-01-18 |