| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy |
| 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical |
| 106H00000X Marriage & Family Therapist |
| 106S00000X Behavior Technician |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional |
| 103K00000X Behavior Analyst |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 103TP0016X Psychologist, Prescribing (Medical) |
| 103TA0700X Psychologist, Adult Development & Aging |
| 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2024-04-22 |