| NPI | 1396273637 |
|---|---|
| Former Name | MISTY ANNE NELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60701395) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2017-05-31 |