| NPI | 1376257683 |
|---|---|
| Former Name | STACEY ANTELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR A2310016) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PTA1637) |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-11-27 |