| NPI | 1376036111 |
|---|---|
| Former Name | KELLY MARIE SYPHARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC9295) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LGP8039) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2020-02-26 |