NPI | 1437664604 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: CO LPC.0014126) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB.0008270) |
101YM0800X Counselor, Mental Health (Licence: CO LPC.0014126) | |
Enumeration Date | 2017-12-08 |
Last Update Date | 2017-12-08 |