| NPI | 1376848259 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OK 4501) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS018097) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2016-11-28 |