| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TA0700X Psychologist, Adult Development & Aging |
| 103TC1900X Psychologist, Counseling |
| 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TF0000X Psychologist, Family |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| 103TP0814X Psychologist, Psychoanalysis |
| 103TP2701X Psychologist, Group Psychotherapy |
| 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2016-09-01 |