NPI | 1376206300 |
---|---|
Former Name | TRACY LEE FICKETT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 1914) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 80) |
Enumeration Date | 2021-10-17 |
Last Update Date | 2021-10-17 |