| NPI | 1386928422 |
|---|---|
| Former Name | JENNIFER LYNN DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WI 5632-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WI 5632-125) |
| 101Y00000X Counselor (Licence: WI 5632-125) | |
| 101YP2500X Counselor, Professional (Licence: WI 5632-125) | |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2023-05-31 |