| NPI | 1447324033 |
|---|---|
| Former Name | SUSAN BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 9853) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 623) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-07-08 |